HHS Inspector General Issues Report on Focused Infection Control Surveys in Nursing Facilities

The HHS Office of Inspector General (OIG) reports that between March 23 and May 30, 2020, states using the Centers for Medicare & Medicaid Services’s (CMS’s) focused infection control survey protocol cited only 68 deficiencies at nursing facilities (only 3% of surveys resulted in a deficiency) while they increased their efforts to support and assist facilities during the pandemic.[1] Between March 23 and May 30, 2020, 1% of onsite surveys resulted in an infection control deficiency; in the comparable period in 2019, 10 percent of surveys led to an infection control deficiency. CMS attributes the small number of infection control deficiencies to the limited scope of the surveys, facilities’ use of a CMS self-assessment tool, and facility vigilance about infection control issues.  States explain that surveyors spent less time onsite, less than two days; one state told OIG that surveyors were onsite for two hours.

State challenges in conducting on-site surveys included difficulties acquiring and fitting personal protective equipment and shortages of surveyors.  States prioritized more of the complaints they received as immediate jeopardy, but they received half as many complaints as in the same period in 2019.  OIG attributes the reduced number of complaints to the ban on visitors. States expressed concern about the backlog of surveys and high-priority complaint investigations. In 2019, high-priority complaints (frequently related to care, residents’ rights, and neglect) resulted in 21,120 deficiencies.

OIG recognizes that while it may have been appropriate to limit surveys to infection control at the beginning of the pandemic, that limitation, combined with the ban on visitors, raises questions about how well the oversight system is identifying problems.  Among its three recommendations, OIG recommends that CMS consider whether to expand the focused survey “to include assessments of additional quality of care requirements.”  CMS did not concur with OIG’s recommendations.

OIG describes its additional work, now underway, on the impact of COVID-19 on nursing homes.  These reports will describe the characteristics of facilities with the largest numbers of COVID-19 cases and deaths and will assess facilities’ reporting of CMS-required information during the pandemic.

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[1] Onsite Surveys of Nursing Homes During the COVID-19 Pandemic: March 23-May 30, 2020,  OEI-01-20-00430 (Dec. 2020),https://oig.hhs.gov/oei/reports/OEI-01-20-00430.pdf